A plane picks up a patient on Nauru. A judge has ordered the urgent transfer of a young woman to Australia.

Nauru’s attempts to block court-ordered medical evacuations of refugees is a problem of the Australian government’s creation, a federal court judge has said in a damning ruling.

Justice Debra Mortimer made the comments early last week while ordering the urgent transfer of a young woman who was ill after trying to take her own life, after she was allegedly raped on the same day she was denied US resettlement.

While lawyers argued, the judgment revealed, the woman told her team she was sitting in her own vomit and asking for help.

In arguing against the transfer, lawyers for Australia’s home affairs minister, Peter Dutton, told the court there had been “ongoing issues” with the Nauruan government not granting approval for air ambulances to land and pick up patients for transfer to Australia.

“The position of the government of Nauru remains one that is capable of interfering with the respondents being able to carry out the orders of this Court,” Mortimer said in last week’s judgment.

Morrison is a leader in a hurry – but not to end the disgrace of Nauru | Katharine Murphy

Read more

“The Commonwealth has created this situation by establishing an arrangement of this kind for regional processing with another sovereign state. Having elected to do that, there inevitably may be risks about the decision-making of that sovereign state from time to time.

“Those arrangements, at least on an urgent application such as this, cannot and should not stand in the way of orders being made to preserve the life and wellbeing of an individual such as the applicant.”

That decision technically rendered the home affairs minister in breach of court orders, but the patient was later able to be put on a commercial flight to Australia, avoiding the need for a Nauruan approval.

In last week’s case Mortimer noted that there were available seats online for the woman’s transport, but previous cases showed that even when seats were available Australian officials hadn’t always managed to book them.

While Mortimer said this was inconsistent and unexplained, the fact that a commercial flight wasn’t always an option had to be addressed between the Australian and Nauruan governments.

Advocates and lawyers had been seeking an urgent evacuation from Nauru for the woman, aged in her mid-20s, who had the previous week attempted to take her own life.

A doctor reported concerns about the woman showing symptoms after her suicide attempt which were not present before it, including vomiting and shortness of breath.

He was “most concerned for the applicant’s medical condition and the risk of rapid deterioration”, and said she required treatment “of a sophisticated nature, possibly in a high dependence unit or intensive care unit”.

The court heard evidence that the previous week the woman had been refused resettlement in the US. That same day she was also allegedly raped on her way back to her accommodation.

This pains me, but it's time to compromise on Australia's cruel asylum seeker policy | Robert Manne

Read more

Her US application was rejected on the basis of her nationality, Mortimer said. Both her name and her nationality are suppressed.

“The evidence is that the effects of the rape are exacerbated by her devastation at what the rape means for her future as a single woman from that country and from that culture, given that culture’s practices,” Mortimer said. “All this is aside from the effects of the rape in other ways.”

Mortimer rejected a request for a 24-hour adjournment, saying the court could not sit by and hope that the risks to her physical and mental health would not eventuate.

“I am satisfied there is a real risk to the applicant’s life. One hopes this will not materialise.”

Dutton’s lawyers, Mortimer noted, presented “a situation of less urgency” than had been described by the woman’s.

Amid the court proceedings, the health provider at the Nauru detention centre, International Health and Medical Services, agreed to have the woman admitted to the supported accommodation compound, RPC1.

Her legal team then contacted her for instructions only to be told: “that she was vomiting, that she was sitting in her own vomit, that she needed help, and that she would consent to go to RPC1”.

Medical and psychiatric reviews of the woman were submitted which showed the woman “clearly meets” criteria for major depressive disorder, anxious distress, and post-traumatic stress disorder as characterised by exposure to sexual violence.

The psychiatrist’s report said the young woman had required immediate inpatient treatment because of her “constellation of symptoms and degree of risk to self”, the judgment said.

“The possible consequences if the applicant does not receive the required evaluation and treatment in a timely fashion include death by suicide or other self-harm, further worsening of her physical and mental health, medical sequelae of malnutrition and a range of other physical complications outlined.”

According to Dutton’s lawyers, the healthcare provider was unaware of the woman’s suicide attempt. But Border Force said it had been advised by the Nauru hospital that she had been admitted there. She apparently did not show symptoms and was discharged the next day.

The day before the court hearing the woman was seen by an IHMS psychiatrist who had “nil current concerns”, but said there would be daily phone contact and home visits every three days under her treatment plan.

Given the conflicting testimony the court sought to hear from someone on Nauru, but the Nauruan official who notified Border Force of the woman’s hospital say was not permitted to give evidence.

• In Australia, the crisis support service Lifeline is 13 11 14. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org